Sevoflurane therapy for life-threatening asthma in children

• Published in: British journal of anaesthesia : BJA Vol. 111; no. 6; pp. 967 - 970
• Main Authors: Schutte, D., Zwitserloot, A.M., Houmes, R., de Hoog, M., Draaisma, J.M., Lemson, J.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.12.2013
• Subjects: Adolescent; anesthetics, inhalation; Anesthetics, Inhalation - therapeutic use; asthma; Asthma - blood; Asthma - drug therapy; Carbon Dioxide - blood; Child; Child, Preschool; Critical Care - methods; Drug Evaluation - methods; Humans; Hydrogen-Ion Concentration; Methyl Ethers - therapeutic use; Partial Pressure; pediatrics; Respiratory Therapy - methods; Retrospective Studies; sevoflurane; Treatment Outcome; anesthetics, inhalation; asthma; sevoflurane; pediatrics
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aet257

Asthma is a common disease in children and often develops early in life. This multicentre retrospective case series describe the use and effectiveness of sevoflurane inhalation therapy in a series of children with severe asthma in the paediatric intensive care unit (PICU). Seven children ranging from 4 to 13 yr of age admitted to the PICU of two tertiary care hospitals in the Netherlands were included. They all were admitted with the diag-nosis of severe asthma requiring invasive mechanical ventilation and were treated with sevoflurane inhalation therapy. The median (range) Pco2 level at the start, after 2 h, and at the end of sevoflurane treatment were 14 (5.1–24.8), 9.8 (5.4–17.0), and 6.2 (4.5–11.4) kPa (P=0.05) while the median (range) pH was 7.02 (6.97–7.36), 7.18 (7.04–7.35), and 7.43 (7.15–7.47) kPa (P=0.01), respectively. The median (range) peak pressure values declined from 30 (23–56) to 20.4 (14–33) cm H2O (P=0.03). No severe adverse effects besides hypotension, with sufficient response to norepinephrine treatment, were seen. Sevoflurane inhalation corrects high levels of Pco2 and provides clinical improvement in mechanically ventilated children with life-threatening asthma who fail to respond to conventional treatment.